JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):43
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263581

P-31. Bariatric Surgery vs. GLP-1 Analogs: Impact on Fertility and Metabolism

Luísa Doria de Almeida¹, Beatriz Silva Almeida Boiani¹, Isabela Shiozawa Nolasco¹, Melanie May Chow¹, Nathania Maria da Silva Motta¹, Janine Maíra Torres Sena Barbosa¹, Julia Roverso Correa Silveira¹, Gabriel Monteiro Pinheiro¹

¹Universidade Santo Amaro - São Paulo - SP - Brasil

Objective: To compare the effects of bariatric surgery and GLP-1 receptor analogs on fertility, metabolic outcomes, and pregnancy in obese women of reproductive age (18-32 years), focusing on personalized therapy and evidence-based decision-making.
Methods: An integrative review was conducted covering articles published between 2020 and 2024, searched in PubMed/MEDLINE and SciELO, using the following descriptors: "Obesity," "Bariatric Surgery," "Glucagon-Like Peptide-1 Receptor Agonists," and "Glucagon-Like Peptide-1." Articles published in Portuguese, English, and Spanish, including original studies, systematic reviews, and meta-analyses that evaluated fertility, ovulatory function, hormonal profile, insulin resistance, weight, body composition, nutritional complications, and pregnancy outcomes, were included. Studies involving pediatric or postmenopausal populations, those with inadequate design or inconsistent methodology, were excluded. Of the 618 articles found, 9 met the eligibility criteria and were relevant for this review. Quality was assessed using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and the data were narratively synthesized, highlighting pathophysiological mechanisms, effect magnitudes, and limitations.
Results: Bariatric surgery, especially Roux-en-Y Gastric Bypass and Sleeve Gastrectomy, demonstrated greater efficacy in weight loss -more intense, rapid, and sustained -compared to GLP-1 agonists such as semaglutide, which showed stabilization of effect after 12–18 months. Both interventions improved glycemic control and insulin sensitivity, but surgery promoted faster responses, especially in long-standing type 2 diabetes, as well as more significant reductions in triglycerides, cholesterol, low-density lipoprotein, and inflammatory markers (C-Reactive Protein, Tumor Necrosis Factor-Alpha and Interleukin-6). Regarding fertility, both approaches benefited women with polycystic ovary syndrome (PCOS), with surgery promoting more pronounced normalization of ovulation, menstrual regularity, and androgen reduction, while GLP-1 analogs showed gradual but significant effects, with increased sex hormone-binding globulin (SHBG) and resumption of ovulation after 24 weeks. In men, both treatments improved hormonal parameters, but data on male fertility are limited. Surgery is associated with obstetric risks, such as nutritional deficiencies - iron, vitamin B12, folate -, requiring postponement of conception for 12–18 months, while GLP-1 analogs require preconception discontinuation due to limited data on fetal safety.
Conclusion: Bariatric surgery is superior for patients with class III obesity and for those whose obesity is associated with severe comorbidities, offering more intense and lasting metabolic and reproductive benefits, especially in women with PCOS. GLP-1 analogs are an effective and less invasive alternative, indicated for lower ovarian reserve, advanced maternal age - taking into account the expected time to conceive -, or if there is a contraindication to surgery. Treatment decisions should be individualized, considering body mass index (BMI), comorbidities, reproductive plans, and patient preferences. A multidisciplinary approach integrating endocrinology, nutrition, and human reproduction is essential to optimize outcomes, with rigorous monitoring to mitigate nutritional and obstetric risks. Combined protocols, such as the use of GLP-1 as neoadjuvant or adjuvant therapy to surgery, warrant further investigation to maximize metabolic and reproductive benefits.